What surgical methods are available?

Today, there are several options for the surgical treatment of shoulder arthrosis. In particular, if conservative therapy no longer achieves any relief of symptoms and the arthrosis has progressed too far, the patient’s level of suffering increases, so that a final solution in the form of surgery is called for. In the past, stiffening of the shoulder joint was mainly performed in these cases.

This makes the joint completely immobile and unusable, the severe pain subsides and arthrosis cannot develop again. Nowadays, this surgical procedure is relegated to the background, as prostheses of the shoulder joint are becoming more common. For this purpose, both the joint surface of the humerus and the joint surface of the shoulder blade, the so-called “glenoid”, are replaced.

Frequently, both joint surfaces are damaged by the longstanding shoulder arthrosis. If the glenoid socket on the shoulder blade is still intact, half a prosthesis can also be inserted. In this case, only the part of the humerus near the joint is replaced by the prosthesis.

Nowadays, a wide variety of prostheses can be selected for different cases. For example, the prostheses can be cemented into the bone if the hold is poor. So-called “inverse prostheses” can also be used if the shoulder muscles are inadequate and improve the overall result. In such prostheses, the upper arm forms the glenoid cavity and the shoulder blade the joint head.

Types of shoulder prosthesis

In cases of very pronounced, severe shoulder arthrosis, an artificial joint replacement can be a good therapeutic option.The goal that is to be achieved with the artificial joint is long-term pain relief, as well as an improvement of the (usually considerably) limited shoulder mobility. Statistically, the functional capability of an artificial shoulder joint is about 15 years, but individual deviations may occur. With a total shoulder prosthesis, a better shoulder function can be expected, but there may be risks in the short or long term because the socket has also been implanted artificially.

With a so-called inverse shoulder prosthesis, the durability is slightly less than 10 years. In this case the head of the joint (actually the humeral head) becomes the joint socket and the glenoid cavity becomes the head of the joint (inverse means that the tasks are exchanged). The existing bones, on which the artificial, inverse joint is mounted, are subject to greater abrasion, which is why the artificial joint can loosen more quickly and may have to be replaced earlier. The inverse shoulder prosthesis provides better active mobility and is stable against possible dislocation, but there is a higher risk of loosening of the head component and infection. For this reason, inverse shoulder prostheses are only used in patients over 70 years of age and in cases of very extensive tendon damage, chronic instability, massive bony destruction and in replacement operations.